Provider Demographics
NPI:1003067075
Name:DI STEFANO, HEATHER (MS, RD, CSG)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DI STEFANO
Suffix:
Gender:F
Credentials:MS, RD, CSG
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 STATE HIGHWAY 34 S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-5128
Mailing Address - Country:US
Mailing Address - Phone:682-999-5835
Mailing Address - Fax:817-476-6133
Practice Address - Street 1:2911 MEDLIN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2330
Practice Address - Country:US
Practice Address - Phone:682-564-2381
Practice Address - Fax:817-476-6133
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80524133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
951447OtherCOMMISSION ON DIETETIC REGISTRATION
TXDT80524OtherTEXAS STATE BOARD OF EXAMINERS OF DIETITIANS